二维斑点追踪技术评价睡眠呼吸暂停患者左心室收缩功能及其影响因素

Assessment of left ventricular systolic dysfunction and its relationships with cardiovascular risk factors in patients with obstructive sleep apnea syndrome by two-dimensional speckle tracking imaging

【摘要】目的应用二维斑点追踪技术（2D-STI）评价左室射血分数（LVEF）正常的阻塞性睡眠呼吸暂停综合征（0sAS）患者不同左室构型的心肌收缩功能及其与心血管危险因素的相关性。方法经多导睡眠仪监测呼吸暂停指数（AHI）≥5次／h确诊为OSAS的患者95例，同时定点监测血压，次日晨行血糖和血脂等生化检查及超声心动图检查，采用双平面Simpson法测量LVEF。根据相对室壁厚度（RWT）≥0．42和左室质量指数（LVMI）≥46．7g／m2.7（女）或49．2g／m2.7（男），将患者按左室构型分为正常构型组（NG）、向心性重构组（cR）、离心性肥厚组（EH）和向心性肥厚组（cH）。应用2I）-STI测量左室心肌不同方向收缩期总体峰值应变：总体长轴应变（GLS）、总体径向应变（GRS）及总体环向应变（Gcs），比较不同构型组间2D-STI参数的差异，并应用多重线性回归分析2D-STI参数与心血管危险因素的相关性。结果①95例OSAS患者中，NG组41例（43．1％），CR组23例（24．2％），EH组16例（16．8％），CH组15例（15．9％），4组间I。VEF差别无统计学意义（P〉0．05），性别、年龄、心率、血压、颈围、腰围、臀围、吸烟史、血脂、空腹血糖、AHI、氧解离指数（0DI）和血氧饱和度（SaO。）等在4组间差异均无统计学意义（P〉0．05）。②2D-STI参数：CH组GLS较低，与其他3组比较差别有统计学意义（P〈0．05），GRS和GCS4组间差别无统计学意义（P〉0．05）。③2D-STI参数与心血管危险因素的Pearson相关分析显示：GLS分别与LVMI（r=0．274）、AHI（r=0．326）、T90（r=0．294）、最低sa02（r=-0．299）、体质量指数（BMI）（r=0．367）相关（P〈0．05），多重线性回归分析显示：AHI、LVMI、BMI是GI．s的独立预测因子（R2=0．219，P〈0．05）。结论①OSAS患者左室CH构型纵向心肌收缩功能受损较重。②OSAS的严重程度、心肌肥厚、肥胖是OSAS患者左室纵向心肌收缩功能受损的独立影响因素。

Objective To investigate left ventricular （LV） systolic dysfunction of different le{t ventricular geometric patterns and its relationships with cardiovascular risk factors by two-dimensional speckle tracking imaging （21）-STI） in patients with obstructive sleep apnea syndrome （OSAS） with normal left ventricular ejection fraction （LVEF）. Methods 95 patients with habitual snoring were diagnosed as OSAS by polysomnography with apnea hypopnea index（AHI）≥5/h. Blood pressure and general clinical characteristics were collected and echocardiography was done next morning. LV geometric patterns was categorized as normal geometry （NG）, concentric remodeling （CR）, eccentric hypertrophy （EH） and concentric hypertrophy （CH） on the basis of relative wall thickness（RWT）〉0.42 and LV mass index （LVMI）〉46.7 g/m2.7 （female） or 49.2 g/m2.7 （male）. LVEF was calculated by bi-plane Simpson＇s rule. Global peak systolic circumferential strain （GCS）,radial strain （GRS） and longitudinal strain （GLS） were measured by 2D-STI. Multivariate linear regression analysis was applied to analyse the relationships between 2D STI parameters and cardiovascular risk factors. Results （1） Of 95 OSAS patients, there were 41 （43.1%） in NG,23 （24.2%） in CR,I6 （16.8%） in EH and 15 （15.9%） in CH respectively. There was no significant difference in LVEF between groups （ P 〉 0.05）. Male, age, heart rate, blood pressure, neck circumference,waist, hip circumference, smoking, TC, TG, HDL, LDL, fasting glucose, AHI, saturation of artery oxygen （SaO2） and oxygen desaturation index （ODD did not differ between groups （ P 〉0.05）. （2） GLS was lower in patients with CH （ P 〈0.05）. GCS and GRS had no significant difference between groups （ P 〉0.05）. （3）In Pearson correlation analysis,GLS was correlated with AHI （ r = 0. 326） ,LVMI （ r = 0.274）,T90 （r = 0.294）, minimum SaO2 （r = -0.299）,body mass index（BMI） （r = 0.367）. In multivariate linear regression analysis, AHI,LVMI,BMI were independent predictors of GLS （R2 = 0. 219, P %0.05）. Conclusions （1）LV longitudinal systolic dysfunction was damaged more severiously in patient of CH with OSAS. （2）Severity of OSAS, LV hypertrophy and obesity were associated with LV longitudinal systolic dysfunction in patient with OSAS.